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Tao BK, Soor D, Micieli JA. Reply to: "Comment on Herpes Zoster in neuro-ophthalmology: a practical approach". Eye (Lond) 2024:10.1038/s41433-024-03378-6. [PMID: 39375486 DOI: 10.1038/s41433-024-03378-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2024] [Revised: 09/24/2024] [Accepted: 09/25/2024] [Indexed: 10/09/2024] Open
Affiliation(s)
- Brendan K Tao
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Deep Soor
- Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada
| | - Jonathan A Micieli
- Faculty of Arts & Science, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
- Kensington Vision and Research Center, Toronto, ON, Canada.
- St. Michael's Hospital, Toronto, ON, Canada.
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2
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Marston D, Xuereb S. Comment on: "Herpes Zoster in neuro-ophthalmology: a practical approach". Eye (Lond) 2024:10.1038/s41433-024-03350-4. [PMID: 39289519 DOI: 10.1038/s41433-024-03350-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Revised: 09/03/2024] [Accepted: 09/13/2024] [Indexed: 09/19/2024] Open
Affiliation(s)
- Duncan Marston
- Department of Ophthalmology, Mater Dei Hospital, Msida, Malta.
| | - Sara Xuereb
- Department of Medicine, Mater Dei Hospital, Msida, Malta
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Hüning S, Werner M, Susok L. [Clinical presentation and treatment of herpes zoster and postherpetic neuralgia]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:733-742. [PMID: 38935292 DOI: 10.1007/s00105-024-05367-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
Herpes zoster (HZ) is a common disease caused by reactivation of varicella zoster virus. Diagnosis is usually based on the typical clinical presentation. Standard treatment includes antiviral, topical and analgesic therapies. As a complication, postherpetic neuralgia (PHN) can result from acute HZ infection, particularly in older and/or immunocompromised people. This can seriously impair the quality of life of those affected and requires adequate analgesia. In addition to the genesis, clinical presentation and treatment recommendations for HZ and PHN, this article also deals in particular with the vaccination prophylaxis recommended by the standing vaccination commission of the Robert Koch Institute (STIKO).
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Affiliation(s)
- S Hüning
- Hautklinik, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland.
| | - M Werner
- Hautklinik, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland
| | - L Susok
- Hautklinik, Klinikum Dortmund gGmbH, Klinikum der Universität Witten/Herdecke, Beurhausstr. 40, 44137, Dortmund, Deutschland
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Beltrami EJ, Gronbeck C, Jain N, Hargis G, Feng H, Grant-Kels JM, Sloan B. Surface anatomy in dermatology: Part I-Clinical importance, diagnostic utility, and impact on medical management. J Am Acad Dermatol 2024; 91:207-220. [PMID: 37429436 DOI: 10.1016/j.jaad.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/12/2023]
Abstract
This continuing medical education series reviews updated Delphi consensus surface anatomy terminology through the lens of common medical and procedural dermatology scenarios, helping to underscore high-yield points that can be readily integrated into clinical practice to support patient care. Part I of this series will discuss the current state of surface anatomy terminology in dermatology, outline implications of precise and consistent terminology, provide an illustrative overview of high-yield consensus terminology, highlight prominent landmarks that can aid in critical diagnoses, and relate the importance of precise terminology to medical management. Part II will draw upon consensus terminology to inform the management of cutaneous malignancies and support optimal outcomes in dermatologic procedures.
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Affiliation(s)
- Eric J Beltrami
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Christian Gronbeck
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Neelesh Jain
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut
| | - Geneva Hargis
- University of Connecticut School of Medicine, Farmington, Connecticut
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut.
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida
| | - Brett Sloan
- Department of Dermatology, University of Connecticut Health Center, Farmington, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut
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Tao BKL, Soor D, Micieli JA. Herpes zoster in neuro-ophthalmology: a practical approach. Eye (Lond) 2024; 38:2327-2336. [PMID: 38538778 PMCID: PMC11306775 DOI: 10.1038/s41433-024-03030-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 08/09/2024] Open
Abstract
Herpes Zoster (HZ) or shingles is the reactivation of the Varicella Zoster Virus (VZV), usually along a single sensory nerve, but can affect both sensory and motor cranial nerves. Major risk factors for HZ include immunosuppressed status and age older than 60 years. In the United States, the lifetime risk of HZ is approximately 30%. Worldwide, the median incidence of HZ is 4-4.5 per 1000 person-years across the Americas, Eurasia, and Australia. HZ ophthalmicus, occurring in 10-20% of patients, is an ophthalmic emergency characterized by VZV reactivation along the V1 branch of the trigeminal nerve. Approximately half of this patient subgroup will go on to develop ocular manifestations, requiring prompt diagnosis and management. While anterior segment complications are more common, neuro-ophthalmic manifestations are rarer and can also occur outside the context of overt HZ ophthalmicus. Neuro-ophthalmic manifestations include optic neuropathy, acute retinal necrosis or progressive outer retinal necrosis, cranial neuropathy (isolated or multiple), orbitopathy, and CNS manifestations. Although typically a clinical diagnosis, diagnosis may be aided by neuroimaging and laboratory (e.g., PCR and serology) studies. Early antiviral therapy is indicated as soon as a presumptive diagnosis of VZV is made and the role of corticosteroids remains debated. Generally, there is wide variation of prognosis with neuro-ophthalmic involvement. Vaccine-mediated prevention is recommended. In this review, we summarize neuro-ophthalmic manifestations of VZV.
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Affiliation(s)
- Brendan Ka-Lok Tao
- Faculty of Medicine, The University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Deep Soor
- Faculty of Arts & Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada
| | - Jonathan A Micieli
- Faculty of Arts & Science, University of Toronto, 100 St. George Street, Toronto, ON, M5S 3G3, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- Division of Neurology, Department of Medicine, University of Toronto, 6 Queen's Park Crescent West, Toronto, ON, M5S 3H2, Canada.
- Kensington Vision and Research Center, 340 College Street, Toronto, ON, M5T 3A9, Canada.
- St. Michael's Hospital, 30 Bond Street, 7 Donnelly Eye Clinic, Toronto, ON, M5B 1W8, Canada.
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Kovacevic J, Samia AM, Shah A, Motaparthi K. Herpes zoster ophthalmicus. Clin Dermatol 2024; 42:355-359. [PMID: 38281688 DOI: 10.1016/j.clindermatol.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
Herpes zoster ophthalmicus (HZO) occurs when latent varicella zoster virus reactivates in the ophthalmic division of the fifth cranial nerve (CNV1). HZO commonly affects older and immunocompromised patients. This disease is considered an ophthalmic emergency due to the wide range of associated ocular symptoms, including severe chronic pain and vision loss. HZO is typically a clinical diagnosis due to its classic presentation of a unilateral vesicular eruption in the dermatomes corresponding to CNV1. Timely treatment is imperative to minimize ocular morbidity in HZO, given that ocular involvement is present in 50% of affected patients.
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Affiliation(s)
- Jasmina Kovacevic
- University of Florida College of Medicine, Gainesville, Florida, USA
| | - Arthur Mark Samia
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Ankit Shah
- Department of Ophthalmology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Kiran Motaparthi
- Department of Dermatology, University of Florida College of Medicine, Gainesville, Florida, USA.
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7
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Scott DAR, Liu K, Danesh-Meyer HV, Niederer RL. Herpes Zoster Ophthalmicus Recurrence: Risk Factors and Long-Term Clinical Outcomes. Am J Ophthalmol 2024; 268:1-9. [PMID: 38909743 DOI: 10.1016/j.ajo.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/23/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To examine the frequency of recurrences, risk factors, and long-term clinical outcomes in subjects with herpes zoster ophthalmicus (HZO). DESIGN Retrospective cohort study. METHODS All subjects with acute HZO seen at a single center from 2006 to 2016 were included in the study. The primary outcome measure was eye disease recurrence. The secondary outcome measure was moderate vision loss (≤20/50). RESULTS A total of 869 patients with acute HZO were identified, with a median follow-up time of 6.3 years (interquartile range 3.7-8.9 years). In all, 551 recurrences were observed, and at least 1 recurrence was seen in 200 subjects (23.0%), with uveitis (34.8%) being the most common. The median time to first recurrence was 3.5 months. Predictors of disease recurrence included immunosuppression (P = .026), higher presenting intraocular pressure (P = .001), corneal involvement (P = .001), and uveitis (P < .001) on multivariate analysis. Topical steroids were initiated in the first month of presentation in 437 subjects, and recurrence was observed in 184 (42.1%) of these subjects. Following cessation of topical steroid treatment, recurrence occurred after a median of 1.4 months (90% within 7 months). Moderate vision loss (≤20/50) occurred in 15.5%, 28.6%, 31.4%, 50.0%, and 57.4% of eyes with 0, 1, 2, 3, and 4 or more recurrences. CONCLUSIONS Recurrence of HZO eye disease is common, with an increased risk of vision loss with more recurrences. These findings indicate the need for close monitoring for potential recurrences, especially after cessation of topical steroid treatment, and in individuals with identified risk factors for recurrence.
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Affiliation(s)
- Daniel A R Scott
- From the Department of Ophthalmology (D.A.R.S., K.L., H.V.D.-M., R.L.N.), Greenlane Clinical Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Kevin Liu
- From the Department of Ophthalmology (D.A.R.S., K.L., H.V.D.-M., R.L.N.), Greenlane Clinical Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Helen V Danesh-Meyer
- From the Department of Ophthalmology (D.A.R.S., K.L., H.V.D.-M., R.L.N.), Greenlane Clinical Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand
| | - Rachael L Niederer
- From the Department of Ophthalmology (D.A.R.S., K.L., H.V.D.-M., R.L.N.), Greenlane Clinical Centre, Te Whatu Ora Health New Zealand, Auckland, New Zealand; Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
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8
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Tofade TO, Chwalisz BK. Neuro-ophthalmic complications of varicella-zoster virus. Curr Opin Ophthalmol 2023; 34:470-475. [PMID: 37603549 DOI: 10.1097/icu.0000000000000996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
PURPOSE OF REVIEW This review broadly describes recent neuro-ophthalmic manifestations of varicella-zoster virus (VZV) reported in literature. RECENT FINDINGS Despite varicella vaccination, the incidence of herpes zoster continues to rise, potentially leading to devastating consequences when ocular complications occur.A small but growing literature documents cases of retinal disease because of varicella reactivation after SARS-CoV-2 vaccination, ischemic optic neuropathy occurring during herpes zoster ophthalmicus, VZV-induced orbital apex syndrome, and immune-mediated ocular complications in patients with prior neuro-ophthalmic manifestations of VZV. SUMMARY It is important for clinicians to keep abreast of the diverse neuro-ophthalmic manifestations of VZV as early diagnosis and treatment often lead to better visual outcomes.
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Affiliation(s)
- Toluwalase O Tofade
- Department of Neurology, Massachusetts General Hospital - Harvard Medical School
| | - Bart K Chwalisz
- Department of Neurology, Massachusetts General Hospital - Harvard Medical School
- Department of Ophthalmology, Massachusetts Eye and Ear - Harvard Medical School, Boston, Massachusetts, USA
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Mok E, Kam KW, Young AL. Corneal nerve changes in herpes zoster ophthalmicus: a prospective longitudinal in vivo confocal microscopy study. Eye (Lond) 2023; 37:3033-3040. [PMID: 36906697 PMCID: PMC10008015 DOI: 10.1038/s41433-023-02469-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 02/02/2023] [Accepted: 02/24/2023] [Indexed: 03/13/2023] Open
Abstract
PURPOSE To study the changes in corneal nerves and corneal sensitivity over a 6-month period in patients with herpes zoster ophthalmicus (HZO) compared with healthy subjects. METHODS This was a prospective longitudinal study on patients with newly diagnosed HZO. In vivo confocal microscopy (IVCM) corneal nerve parameters and corneal sensitivity were measured and compared between eyes with HZO, contralateral eyes and controls at baseline, 2 and 6 months. RESULTS Fifteen subjects with HZO and 15 healthy age and sex matched controls were recruited. HZO eyes revealed a reduction in corneal nerve branch density (CNBD) from baseline to 2 months (9.65 ± 5.75 vs. 5.90 ± 6.87/mm2, p = 0.018), and decreased corneal nerve fibre density (CNFD) at 2 months when compared with control (p = 0.025). However, these differences resolved by 6 months. HZO fellow eyes demonstrated increased corneal nerve fibre area (CNFA), corneal nerve fibre width (CNFW) and corneal nerve fractal dimension (CNFrD) at 2 months compared with baseline (p = 0.025, 0.031, 0.009). There was no change in corneal sensitivity for both HZO affected and HZO fellow eyes from baseline or over time, nor was it different from sensitivity in controls. CONCLUSION Corneal denervation was present at 2 months in HZO eyes, with an observed recovery by 6 months. HZO fellow eyes demonstrated increased corneal nerve parameters at 2 months, which could represent a proliferative response to nerve degeneration. IVCM is useful in monitoring corneal nerve changes, and is more sensitive in detecting nerve alterations than esthesiometry.
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Affiliation(s)
- Eugenie Mok
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ka Wai Kam
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alvin L Young
- Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital and Alice Ho Miu Ling Nethersole Hospital, New Territories, Hong Kong.
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong.
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10
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Narainswami N. Case Report. S Afr Med J 2023; 113:28-29. [PMID: 37882117 DOI: 10.7196/samj.2023.v113i8.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 10/27/2023] Open
Abstract
Cavernous sinus thrombosis is a rare life-threatening complication of herpes zoster ophthalmicus (HZO). This case highlights the importance of at least considering the diagnosis in all cases of HZO, as the consequences of missing it can be disastrous.
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Affiliation(s)
- N Narainswami
- Grey's Hospital Eye Clinic, Pietermaritzburg, South Africa.
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11
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Jabin M, Alam Z, Chung E, Shalabi M, Siddiqui B. A Case of Herpes Zoster Ophthalmicus in a Recently Transplanted Renal Patient. Cureus 2023; 15:e40899. [PMID: 37492822 PMCID: PMC10365146 DOI: 10.7759/cureus.40899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 07/27/2023] Open
Abstract
Herpes Zoster Ophthalmicus (HZO) is a common manifestation of the reactivated Varicella Zoster virus, primarily affecting the eye and trigeminal nerve. This case study presents the clinical course of a 51-year-old male who underwent a renal transplant due to end-stage renal disease, further complicating the management of HZO. The patient's medical history also includes hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD), cerebrovascular accident (CVA), and retinal detachment. Upon examination, the diagnosis of HZO was confirmed based on the presence of a characteristic unilateral vesicular rash in the V1 cranial nerve dermatomal distribution, accompanied by ophthalmic symptoms such as eyelid swelling and visual impairment. Given the patient's immunosuppressive regimen post-transplant, intravenous acyclovir was initiated for antiviral therapy, while supportive care was provided for pain control. Notably, the patient experienced a subsequent decrease in pain intensity and improvement in the vesicular rash. This case highlights the challenges in managing HZO in patients with a history of renal transplant and multiple comorbidities, emphasizing the importance of tailored treatment strategies to optimize patient outcomes. Further research is warranted to better understand the impact of immunosuppression and comorbidities on the course and management of HZO in this population.
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Affiliation(s)
| | - Zaryab Alam
- Medicine, Texas A&M College of Medicine, Bryan, USA
| | - Evan Chung
- Medicine, Burnett School of Medicine, Fort Worth, USA
| | - Mojahed Shalabi
- Internal Medicine, Baylor Scott & White All Saints, Fort Worth, USA
| | - Bismah Siddiqui
- Internal Medicine, Baylor Scott & White All Saints, Fort Worth, USA
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Labetoulle M, Boutolleau D, Burrel S, Haigh O, Rousseau A. Herpes simplex virus, varicella-zoster virus and cytomegalovirus keratitis: Facts for the clinician. Ocul Surf 2023; 28:336-350. [PMID: 34314898 DOI: 10.1016/j.jtos.2021.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/05/2021] [Accepted: 07/18/2021] [Indexed: 01/16/2023]
Abstract
Keratitis due to Herpes simplex virus (HSK), Varicella-Zoster virus (VZK) and Cytomegalovirus remains a frequent source of concern for many ophthalmologists. They are a frequent cause of emergency consultations at eye care centers and carry the risk of permanent loss of visual acuity or visual quality and/or chronic neurotrophic keratitis, resulting in a significant decrease in the quality of life. HSK and VZK can affect the corneal epithelium, stroma, or endothelium or a combination of layers. In contrast, most cases of CMV keratitis present as isolated endothelitis (CMVE), a clinical entity that has been described within the last 2 decades. These three types of viral keratitis are characterized by a high frequency of recurrences and each new episode increases the risk of sequelae. Hence, ophthalmologists must adapt the treatment to the clinical presentation of each recurrent episode in order to mitigate the immediate consequences of viral replication and the immune response on corneal transparency. In patients with frequent recurrences, preventive long-term antiviral treatment is strongly recommended. However, in some rare cases, continuous exposure to antivirals may promote the emergence of resistant viral strains, which can be difficult to manage. In the future, the introduction of new antiviral drugs, with differing modes of action compared to current medical therapy, could be an alternative until a truly effective preventive solution, such as a vaccine, is available.
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Affiliation(s)
- Marc Labetoulle
- Ophthalmologie Department, Hôpital Bicêtre, APHP, Université Paris Sud, 94275, Le Kremlin-Bicêtre, France; Center for Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Infrastructure, CEA, Université Paris Sud, Inserm U1184 18 Route Du Panorama, 92265, Fontenay-aux-Roses Cedex, France.
| | - David Boutolleau
- Virology Department, Hôpital Pitié-Salpétrière, APHP, National Reference Center for Herperviruses (Associated Laboratory), Paris, France; Sorbonne University, INSERM UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Paris, France
| | - Sonia Burrel
- Virology Department, Hôpital Pitié-Salpétrière, APHP, National Reference Center for Herperviruses (Associated Laboratory), Paris, France; Sorbonne University, INSERM UMR-S 1136, Pierre Louis Institute of Epidemiology and Public Health (IPLESP), Paris, France
| | - Oscar Haigh
- Center for Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Infrastructure, CEA, Université Paris Sud, Inserm U1184 18 Route Du Panorama, 92265, Fontenay-aux-Roses Cedex, France
| | - Antoine Rousseau
- Ophthalmologie Department, Hôpital Bicêtre, APHP, Université Paris Sud, 94275, Le Kremlin-Bicêtre, France; Center for Immunology of Viral Infections and Autoimmune Diseases (IMVA), IDMIT Infrastructure, CEA, Université Paris Sud, Inserm U1184 18 Route Du Panorama, 92265, Fontenay-aux-Roses Cedex, France
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Muto T, Imaizumi S, Kamoi K. Viral Conjunctivitis. Viruses 2023; 15:v15030676. [PMID: 36992385 PMCID: PMC10057170 DOI: 10.3390/v15030676] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
Viruses account for 80% of all cases of acute conjunctivitis and adenovirus; enterovirus and herpes virus are the common causative agents. In general, viral conjunctivitis spreads easily. Therefore, to control the spread, it is crucial to quickly diagnose illnesses, strictly implement hand washing laws, and sanitize surfaces. Swelling of the lid margin and ciliary injection are subjective symptoms, and eye discharge is frequently serofibrinous. Preauricular lymph node swelling can occasionally occur. Approximately 80% of cases of viral conjunctivitis are caused by adenoviruses. Adenoviral conjunctivitis may become a big global concern and may cause a pandemic. Diagnosis of herpes simplex viral conjunctivitis is crucial for using corticosteroid eye solution as a treatment for adenovirus conjunctivitis. Although specific treatments are not always accessible, early diagnosis of viral conjunctivitis may help to alleviate short-term symptoms and avoid long-term consequences.
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Affiliation(s)
- Tetsuaya Muto
- Department of Ophthalmology, Dokkyo Medical University Saitama Medical Center, Koshigaya 343-8555, Japan
- Imaizumi Eye Hospital, Koriyama 963-8877, Japan
- Correspondence:
| | | | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical Dental University, Tokyo 113-8519, Japan
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14
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Iancu GM, Stănilă DM, Cipăian RC, Rotaru M. Ophthalmic herpes zoster with severe complications in an immunocompromised patient: A case report and review of the literature. Exp Ther Med 2022; 23:214. [PMID: 35126717 PMCID: PMC8796286 DOI: 10.3892/etm.2022.11138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/01/2021] [Indexed: 12/29/2022] Open
Abstract
The increasing incidence for herpes zoster, including its ophthalmic form, is based on physiological (senescence) and acquired immunosuppression, particularly under oncologic treatment. The immunocompromised status of the patient favors the appearance of severe complications. The patient, aged 54, with chronic lymphocytic leukemia, presented 1 week from the onset with an erythematous, vesicular-bullous rash on the right trigeminal nerveʼs ophthalmic dermatome, marked edema, intense pain and large submandibular ganglion masses. There were cutaneous (necrotic ulcerations superinfected with methicillin-resistant Staphylococcus aureus), ocular (keratoconjunctivitis, total ophthalmoplegia, lagophthalmia, anterior hemorrhagic uveitis with hyphema and right eye blindness) and neurological (postherpetic neuralgia) complications. Systemic therapy was performed with acyclovir, antibiotics, supportive, rebalancing and symptomatics. With regards to treatment for skin ulcers, disinfection and necrectomy were performed, and epithelialization agents were subsequently administrated. At the ocular level, the ophthalmologist carefully monitored the patient and administered antivirals, antibiotics, epithelialization agents and autologous serum. The evolution of the case recorded severe, disabling complications, with extensive eyelid necrosis and definitive blindness. In this case, the severity of the ophthalmic herpes zoster (OHZ) was favored by the synergistic action of four factors: Acquired immunosuppression (chronic lymphocytic leukemia), delayed consultation, superinfectious lesions and patient non-compliance regarding the chronic lymphocytic leukemia treatment.
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Affiliation(s)
- Gabriela Mariana Iancu
- Department of Dermatology, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania.,Clinic of Dermatology, County Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Dan Mircea Stănilă
- Department of Ophthalmology, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania.,Clinic of Ophthalmology, County Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Remus Călin Cipăian
- Department of Internal Medicine, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania.,Clinic of Internal Medicine, County Emergency Hospital of Sibiu, 550245 Sibiu, Romania
| | - Maria Rotaru
- Department of Dermatology, Faculty of Medicine, Lucian Blaga University, 550169 Sibiu, Romania.,Clinic of Dermatology, County Emergency Hospital of Sibiu, 550245 Sibiu, Romania
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Abstract
Glaucoma is an intraocular pressure-related ophthalmic disease with multiple causes that results in an optic neuropathy and vision loss. Intraocular pressure elevation is among its strongest risk factors. While glaucoma is mostly primary in etiology, secondary glaucoma is not infrequent. Recognizing its cause is imperative, since treatment is often different depending on the pathophysiologic mechanism. Numerous clinically relevant ophthalmic infections can result in robust inflammatory responses that may result in pressure elevation or intraocular anatomic configurations that predispose to pressure elevation. Knowing the mechanisms by which these infections can lead to glaucoma is critical in treating, and we consolidate what is currently known in regards to how infectious diseases lead to glaucoma.
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Bradford CA, Melson AT. Ocular Complaints, Disease, and Emergencies in the General Medical Setting. Med Clin North Am 2021; 105:409-423. [PMID: 33926638 DOI: 10.1016/j.mcna.2021.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Primary care physicians see nearly half of all clinical visits, and 2% to 3% of those are for eye complaints. Taking a good ocular history is essential to establishing the diagnosis. Patient complaints fall into several categories including visual change, redness, and pain. Primary care physicians can screen for patients at risk of vision loss from glaucoma, diabetes, and toxic medication and ensure that patients have appropriate eye evaluations. Examination techniques such as direct ophthalmoscopy, evaluation of the red reflex, eversion of the upper lid, checking pupillary response, and using fluorescein to stain the cornea are helpful in evaluating patients' ocular complaints.
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Affiliation(s)
- Cynthia A Bradford
- Department of Ophthalmology, University of Oklahoma, College of Medicine, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA.
| | - Andrew T Melson
- Department of Ophthalmology, University of Oklahoma, College of Medicine, Dean A. McGee Eye Institute, 608 Stanton L. Young Boulevard, Oklahoma City, OK 73104, USA
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Amano E, Machida A. Teaching NeuroImages: Hutchinson Sign in Herpes Zoster Ophthalmicus. Neurology 2020; 96:e2033-e2034. [PMID: 33268563 DOI: 10.1212/wnl.0000000000011285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Eiichiro Amano
- From the Department of Neurology, Tsuchiura Kyodo General Hospital, Japan.
| | - Akira Machida
- From the Department of Neurology, Tsuchiura Kyodo General Hospital, Japan
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18
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Chiang PH, Wang CH, Chen CB. Painful nasal and oral lesions. BMJ 2020; 371:m3778. [PMID: 33239314 DOI: 10.1136/bmj.m3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Pin-Hsuan Chiang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Hui Wang
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chun-Bing Chen
- Department of Dermatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Abstract
The article reviews the main ocular features of Herpes Zoster Ophthalmicus (HZO) including Ramsay-Hunt and Tolosa-Hunt syndromes that involve III, IV and VI pairs of cranial nerves and I branch of the trigeminal nerve, and describes treatment methods of its active manifestations and postherpetic neuralgia, as well as herpes zoster vaccination practices.
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Affiliation(s)
| | | | - O I Pimonova
- Research Institute of Eye Diseases, Moscow, Russia
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Abstract
BACKGROUND Approximately 1 million new cases of herpes zoster (HZ) occur in the United States annually, including 10%-20% with herpes zoster ophthalmicus (HZO). Postherpetic neuralgia, a debilitating pain syndrome occurs in 30% HZ, whereas 50% HZO develop ophthalmic complications. Diplopia from cranial nerve palsy occurs in less than 30% HZO, whereas optic neuropathy is seen in less than 1% HZO. We reviewed recent developments in the diagnosis, treatment, and prevention of HZ as well as neurological and ophthalmological complications of relevance to the neuro-ophthalmologist. EVIDENCE ACQUISITION We searched the English language literature on Pubmed and Google scholar for articles relevant to the various sections of this review. RESULTS Antiviral treatment should be initiated within 48-72 hours of onset of HZ and HZO to decrease pain and reduce complications. We recommend neuroimaging in all patients with neuro-ophthalmic manifestations such as diplopia and acute vision loss. Diagnostic confirmation using polymerase chain reaction and serology on paired serum and cerebrospinal fluid samples should be obtained in those with neurological signs and symptoms or abnormal imaging. Patients with neurological and/or retinal varicella zoster virus (VZV) infection should be treated promptly with intravenous acyclovir. Patients with isolated optic neuropathy or cranial nerve palsy can be managed with oral antivirals. The prognosis for visual recovery is good for patients with isolated optic neuropathy and excellent for patients with isolated ocular motor cranial nerve palsy. CONCLUSIONS HZ produces a spectrum of potentially blinding and life-threatening complications that adversely affect quality of life and increase health care costs. Individuals at risk for HZ, such as the elderly and immunocompromised, should be encouraged to receive the highly effective VZV vaccine to prevent HZ and its complications.
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Crossed Zoster Syndrome: A Rare Clinical Presentation Following Herpes Zoster Ophthalmicus. Neurol Sci 2020; 47:711-713. [PMID: 32389129 DOI: 10.1017/cjn.2020.91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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22
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Gross GE, Eisert L, Doerr HW, Fickenscher H, Knuf M, Maier P, Maschke M, Müller R, Pleyer U, Schäfer M, Sunderkötter C, Werner RN, Wutzler P, Nast A. [S2k guideline for the diagnosis and therapy of zoster and post-zoster neuralgia]. GMS INFECTIOUS DISEASES 2020; 8:Doc01. [PMID: 32373426 PMCID: PMC7187398 DOI: 10.3205/id000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Diese Leitlinie richtet sich an Dermatologen, Ophthalmologen, HNO-Ärzte, Pädiater, Neurologen, Virologen sowie Infektiologen, Anästhesisten und Allgemeinmediziner in Klinik und Praxis und dient zur Information für andere medizinische Fachrichtungen, die an der Behandlung des Zoster beteiligt sind. Darüber hinaus soll die Leitlinie Kostenträgern und politischen Entscheidungsträgern zur Orientierung dienen. Die Leitlinie wurde im formellen Konsensusverfahren (S2k) von Dermatologen, Virologen/Infektiologen, Ophthalmologen, HNO-Ärzten, Neurologen, Pädiatern und Anästhesisten/Schmerzmedizinern erstellt. Die Leitlinie stellt einen Überblick über die klinische und molekulare Diagnostik sowie den Antigennachweis, die Antikörperkultur und Viruskultur dar. Diagnostisch besondere Situationen und komplizierte Verläufe der Erkrankung finden ebenfalls Berücksichtigung. Die antivirale Therapie des Zoster und der Postzosterneuralgie wird im Allgemeinen und für besondere Situationen dargelegt. Detaillierte Angaben zur Schmerzbehandlung finden Erwähnung und sind in einer Übersicht dargestellt. Ebenso werden die lokaltherapeutischen Maßnahmen thematisiert.
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Affiliation(s)
- Gerd E. Gross
- Universitätsmedizin Rostock, Universitätsklinik für Dermatologie und Venerologie, Rostock, Deutschland
| | - Lisa Eisert
- Vivantes Klinikum Neukölln, Klinik für Dermatologie und Venerologie, Berlin, Deutschland
| | - Hans Wilhelm Doerr
- Universitätsklinikum Frankfurt, Institut für Medizinische Virologie, Frankfurt (Main), Deutschland
| | - Helmut Fickenscher
- Christian-Albrechts-Universität zu Kiel und Universitätsklinikum Schleswig-Holstein, Institut für Infektionsmedizin, Kiel, Deutschland
| | - Markus Knuf
- Helios Dr. Horst Schmidt Kliniken Wiesbaden, Kinder- und Jugendklinik, Wiesbaden, Deutschland
| | - Philip Maier
- Universitätsklinikum Freiburg, Klinik für Augenheilkunde, Freiburg, Deutschland
| | - Matthias Maschke
- Krankenhaus der Barmherzigen Brüder Trier, Klinik für Neurologie, Neurophysiologie und neurologische Frührehabilitation, Trier, Deutschland
| | - Rainer Müller
- Medizinische Fakultät Carl Gustav Carus der Technischen Universität Dresden, Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Dresden, Deutschland
| | - Uwe Pleyer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augenklinik, Berlin, Deutschland
| | - Michael Schäfer
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie und operative Intensivmedizin, Berlin, Deutschland
| | - Cord Sunderkötter
- Universitätsklinikum Halle (Saale), Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Halle (Saale), Deutschland
| | - Ricardo N. Werner
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergy, Division of Evidence-based Medicine (dEBM), Berlin, Deutschland
| | - Peter Wutzler
- Universitätsklinikum Friedrich-Schiller-Universität Jena, Virologie, Jena, Deutschland
| | - Alexander Nast
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergy, Division of Evidence-based Medicine (dEBM), Berlin, Deutschland,*To whom correspondence should be addressed: Alexander Nast, Charité – Universitätsmedizin Berlin Department of Dermatology, Venereology und Allergy Division of Evidence-based Medicine (dEBM), Charitéplatz 1, 10117 Berlin, Deutschland, Tel.: +49(0)30-450618313, Fax: +49(0)30-4507518977, E-mail:
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Katherine SBH, Ngim YS, Juliana J, Ramli N. Herpes zoster keratouveitis with hypopyon and hyphema. Taiwan J Ophthalmol 2020; 10:54-57. [PMID: 32309125 PMCID: PMC7158927 DOI: 10.4103/tjo.tjo_20_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/26/2018] [Indexed: 11/04/2022] Open
Abstract
This study aims to report two cases with an uncommon, early manifestation of herpes zoster ophthalmicus which is keratouveitis. The first patient is a 61-year-old female who had presented with painful facial skin eruption and right eye redness without impairment of vision. She was treated initially as herpes zoster blepharoconjunctivitis; however, the disease had progressed to neurotrophic keratitis with severe anterior chamber reaction manifested by a mixture of hypopyon and hyphema. The second patient is a 74-year-old female who had presented after 2 weeks of facial skin eruption with blurring of vision and similar keratouveitic manifestations. Both patients had poor visual outcome due to severe ocular inflammation.
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Affiliation(s)
| | - You Siang Ngim
- Department of Ophthalmology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Jalaluddin Juliana
- Department of Ophthalmology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Norlina Ramli
- Department of Ophthalmology, University of Malaya Medical Center, Kuala Lumpur, Malaysia
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24
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Herpes Zoster Ophthalmicus with Unilateral Sixth Nerve Palsy. Can J Neurol Sci 2020; 47:273-274. [DOI: 10.1017/cjn.2019.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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25
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Bogdanov I, Darlenski R, Hristakieva E, Manuelyan K. The rash that presents as a vesiculobullous eruption. Clin Dermatol 2020; 38:19-34. [DOI: 10.1016/j.clindermatol.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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26
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Buell KG, Trumbo SP, Haase VH. A Unilateral Facial Rash with Eye Involvement. Am J Med 2019; 132:823-825. [PMID: 30849384 DOI: 10.1016/j.amjmed.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Kevin G Buell
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tenn.
| | - Silas P Trumbo
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - Volker H Haase
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tenn; Vanderbilt University School of Medicine, Nashville, Tenn; Medical and Research Services, Department of Veterans Affairs Hospital, Tennessee Valley Healthcare System, Nashville
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27
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Affiliation(s)
- Darren Shu Jeng Ting
- Sunderland Eye Infirmary, Sunderland, UK
- Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
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28
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Peng RM, Guo YX, Xiao GG, Lu Q, Sun BJ, Hong J. Clinical Manifestations and Characteristics of In Vivo Confocal Microscopy in Varicella Zoster Virus-Related Corneal Endotheliitis. Ocul Immunol Inflamm 2018; 27:1270-1279. [PMID: 30252558 DOI: 10.1080/09273948.2018.1521435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Rong-mei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, P. R. China
| | - Yu-xin Guo
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, P. R. China
| | - Ge-ge Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, P. R. China
| | - Qing Lu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, P. R. China
| | - Bin-jia Sun
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, P. R. China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China
- Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing, P. R. China
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29
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Abstract
PURPOSE OF REVIEW Neuralgias are characterized by pain in the distribution of a cranial or cervical nerve. Typically, they are brief, paroxysmal, painful attacks, although continuous neuropathic pain may occur. The most commonly encountered conditions are trigeminal, postherpetic, and occipital neuralgia. Less common neuralgias include glossopharyngeal, superior laryngeal, auriculotemporal, and nervus intermedius neuralgia, among others. The approach to diagnosis and treatment of this group of disorders is reviewed. RECENT FINDINGS Recent guidelines of medication administration, the use of botulinum toxin, and more targeted procedures have improved treatment of neuralgias. Patients who present with neuralgias should have imaging studies to investigate for structural abnormalities unless the etiology is apparent. Management of both common and rare neuralgias can be challenging and is best guided by the most recent available evidence.
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Affiliation(s)
- Danielle Wilhour
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
| | - Stephanie J Nahas
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
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31
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Tugal-Tutkun I, Cimino L, Akova YA. Review for Disease of the Year: Varicella Zoster Virus-Induced Anterior Uveitis. Ocul Immunol Inflamm 2017; 26:171-177. [DOI: 10.1080/09273948.2017.1383447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ilknur Tugal-Tutkun
- Istanbul Faculty of Medicine, Department of Ophthalmology, Istanbul University, Istanbul, Turkey
| | - Luca Cimino
- Ocular Immunology Department, Azienda Unità Sanitaria Locale di Reggio Emilia-IRCCS, Reggio Emilia, Italy
| | - Yonca Aydin Akova
- Department of Ophthalmology, Bayindir Kavaklidere Hospital, Ankara, Turkey
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32
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Vrcek I, Choudhury E, Durairaj V. Herpes Zoster Ophthalmicus: A Review for the Internist. Am J Med 2017; 130:21-26. [PMID: 27644149 DOI: 10.1016/j.amjmed.2016.08.039] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 08/22/2016] [Accepted: 08/22/2016] [Indexed: 02/04/2023]
Abstract
Herpes zoster ophthalmicus occurs due to reactivation of the varicella zoster virus in the ophthalmic branch of the fifth cranial nerve. This disease primarily affects the elderly as well as the immunocompromised and can result in a wide range of ophthalmic morbidity. Systemic antiviral therapy is the mainstay of treatment; however, consultation with an ophthalmologist is typically indicated. Herein we present a review of this common entity including epidemiology, pathophysiology, evaluation, treatment, follow-up, and an update on the current body of literature.
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33
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Mun CY, Jung MS. Clinical Features and Risk Factors of Herpes Zoster Ophthalmicus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.12.1317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Chi Young Mun
- Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Moon Sun Jung
- Department of Ophthalmology, Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
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No light at the end of the tunnel… an unfortunate case of varicella-associated progressive outer retinal necrosis in a patient with neglected HIV infection. IDCases 2016; 6:97-99. [PMID: 27882300 PMCID: PMC5118589 DOI: 10.1016/j.idcr.2016.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022] Open
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35
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Lee YM, Chang MH. Cases of Oculomotor Nerve Palsy in Herpes Zoster Ophthalmicus. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.2.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Yu Mi Lee
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
| | - Moo Hwan Chang
- Department of Ophthalmology, Dankook University Medical College, Cheonan, Korea
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36
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Hyun SY, Kim DY, Chae JB. Multiple Serous Chorioretinopathy after Facial Herpes Zoster. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2016. [DOI: 10.3341/jkos.2016.57.1.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Yoon Hyun
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Dong Yoon Kim
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ju Byung Chae
- Department of Ophthalmology, Chungbuk National University College of Medicine, Cheongju, Korea
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38
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Kim H, Gentile NM, Poterucha TH. 88-Year-Old Man With Mental Status Changes and Vesicular Lesions. Mayo Clin Proc 2015; 90:1131-4. [PMID: 26250729 DOI: 10.1016/j.mayocp.2015.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/14/2015] [Accepted: 02/18/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Hidong Kim
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Nicole M Gentile
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Mayo Clinic, Rochester, MN
| | - Thomas H Poterucha
- Advisor to residents and Consultant in Primary Care Internal Medicine, Mayo Clinic, Rochester, MN.
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Johnson RW, Alvarez-Pasquin MJ, Bijl M, Franco E, Gaillat J, Clara JG, Labetoulle M, Michel JP, Naldi L, Sanmarti LS, Weinke T. Herpes zoster epidemiology, management, and disease and economic burden in Europe: a multidisciplinary perspective. THERAPEUTIC ADVANCES IN VACCINES 2015; 3:109-20. [PMID: 26478818 PMCID: PMC4591524 DOI: 10.1177/2051013615599151] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Herpes zoster (HZ) is primarily a disease of nerve tissue but the acute and longer-term manifestations require multidisciplinary knowledge and involvement in their management. Complications may be dermatological (e.g. secondary bacterial infection), neurological (e.g. long-term pain, segmental paresis, stroke), ophthalmological (e.g. keratitis, iridocyclitis, secondary glaucoma) or visceral (e.g. pneumonia, hepatitis). The age-related increased incidence of HZ and its complications is thought to be a result of the decline in cell-mediated immunity (immunosenescence), higher incidence of comorbidities with age and social-environmental changes. Individuals who are immunocompromised as a result of disease or therapy are also at increased risk, independent of age. HZ and its complications (particularly postherpetic neuralgia) create a significant burden for the patient, carers, healthcare systems and employers. Prevention and treatment of HZ complications remain a therapeutic challenge despite recent advances. This is an overview of the multidisciplinary implications and management of HZ in which the potential contribution of vaccination to reducing the incidence HZ and its complications are also discussed.
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Affiliation(s)
- Robert W. Johnson
- Senior Research Fellow, Clinical Sciences, University of Bristol, 9 Ridgeway Road, Long Ashton, Bristol, BS41 9EX, UK
| | | | - Marc Bijl
- Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, The Netherlands
| | - Elisabetta Franco
- Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy
| | - Jacques Gaillat
- Annecy-Genevois Hospital, Infectious Diseases Department, Annecy, France
| | - João G. Clara
- Lisbon Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Marc Labetoulle
- Service d’Ophtalmologie, Hôpital Bicêtre, APHP, Université Paris-Sud, France Département de Virologie, Institute for Integrative Biology of the Cell (I2BC), CNRS, Gif/Yvette, France
| | - Jean-Pierre Michel
- Department of Geriatrics, University Hospitals of Geneva, Belle Idée, Geneva, Switzerland
| | - Luigi Naldi
- Department of Dermatology, Azienda Ospedaliera papa Giovanni XXIII, Bergamo, Italy
| | | | - Thomas Weinke
- Klinikum Ernst von Bergmann, Klinik für Gastroenterologie und Infekiologie, Potsdam, Germany
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40
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Zamora-de la Cruz D, Saucedo-Rodriguez LR, Jauregui-Franco RO, Soria-Orozco CL, Pérez-Gómez HR, Ascencio-Tene CM. Herpes zóster oftálmico en paciente pediátrico sin inmunocompromiso. REVISTA MEXICANA DE OFTALMOLOGÍA 2015. [DOI: 10.1016/j.mexoft.2014.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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41
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Rousseau A, Nasser G, Chiquet C, Barreau E, Gendron G, Kaswin G, M’Garrech M, Benoudiba F, Ducreux D, Labetoulle M. Diffusion tensor magnetic resonance imaging of trigeminal nerves in relapsing herpetic keratouveitis. PLoS One 2015; 10:e0122186. [PMID: 25830672 PMCID: PMC4382307 DOI: 10.1371/journal.pone.0122186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 02/09/2015] [Indexed: 01/27/2023] Open
Abstract
Background Corneal hypoesthesia is the landmark of HSV and VZV keratitis and can lead to neurotrophic keratitis. Diffusion tensor imaging (DTI) is a new magnetic resonance imaging (MRI) derived technique, which offers possibilities to study axonal architecture. We aimed at assessing the potential impact of recurrent HSV or VZV-related keratitis on the axonal architecture of trigeminal nerves using DTI. Design Prospective non-interventional study. Participants Twelve patients and 24 controls. Methods DTI using MRI of the trigeminal fibers and corneal esthesiometry using the Cochet-Bonnet esthesiometer were acquired for patients affected by unilateral and recurrent HSV or VZV-related keratitis (3 months after the last corneal inflammatory event), and control subjects with no history of ocular or neuronal disease affecting the trigeminal pathways. Main Outcome Measures Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) were compared between the 2 eyes of both patients and controls, and correlated with corneal esthesiometry. Results FA was lower in the trigeminal fibers ipsilateral to the affected eye compared to the non-affected side (0.39±0.02 versus 0.46±0.04, P=0.03). This difference was more important than the intra-individual variability observed in controls. Concomitantly, the asymmetry in ADC results was significantly correlated with the loss of corneal sensitivity in the affected eye. Conclusions Corneal hypoesthesia related to HSV and VZV keratitis is associated with persistent modifications in the architecture and functionality of the trigeminal fibers. These results add further explanation to the pathogenesis of HSV and VZV-induced neurotrophic keratitis, which may occur despite an apparent quiescence of the disease.
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Affiliation(s)
- Antoine Rousseau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Ghaïdaa Nasser
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Christophe Chiquet
- Department of Ophthalmology, Grenoble University Hospital, Grenoble, France
| | - Emmanuel Barreau
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Gael Gendron
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Godefroy Kaswin
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Mohamed M’Garrech
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Farida Benoudiba
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
| | - Denis Ducreux
- Department of Neuroradiology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
- * E-mail: (ML); (DD)
| | - Marc Labetoulle
- Department of Ophthalmology, Bicêtre Hospital, Assistance Publique—Hôpitaux de Paris, Paris-Sud University, Le Kremlin-Bicêtre, France
- * E-mail: (ML); (DD)
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Szent-Ivanyi J, Hassan AS, Teimory M. Herpes zoster ophthalmicus: is the globe involved? BMJ Case Rep 2014; 2014:bcr-2014-204566. [PMID: 24744079 DOI: 10.1136/bcr-2014-204566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Potts A, Williams GJ, Olson JA, Pollock KGJ, Murdoch H, Cameron JC. Herpes zoster ophthalmicus reduction: implementation of shingles vaccination in the UK. Eye (Lond) 2014; 28:247-8. [PMID: 24622628 DOI: 10.1038/eye.2013.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- A Potts
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
| | - G J Williams
- Tennant Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK
| | - J A Olson
- The Eye Clinic, Aberdeen Royal Infirmary, Aberdeen, UK
| | - K G J Pollock
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
| | - H Murdoch
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
| | - J C Cameron
- Vaccine Preventable Diseases, Health Protection Scotland, NHS National Services Scotland, Meridian Court, Glasgow, UK
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Herpes Zoster Ophthalmicus Masked by Hymenoptera Stings. Am J Med Sci 2014; 347:79. [DOI: 10.1097/maj.0b013e31826b29bb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Teran CG, Medows M. Herpes zoster ophthalmicus in a healthy child. BMJ Case Rep 2013; 2013:bcr-2013-009702. [PMID: 23697452 DOI: 10.1136/bcr-2013-009702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Carlos G Teran
- Department of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
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Kim YR, Cho NC, You IC. Comparison of Herpes Zoster Ophthalmicus in Patients 60 Years Older Versus Younger than 60 Years. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2013. [DOI: 10.3341/jkos.2013.54.4.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- You Ra Kim
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - Nam Chun Cho
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
| | - In Cheon You
- Department of Ophthalmology, Chonbuk National University Medical School, Jeonju, Korea
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Wakil SM, Ajlan R, Arthurs B. Herpes zoster ophthalmicus complicated by ipsilateral isolated Bell's palsy: a case report and review of the literature. Can J Ophthalmol 2012; 47:339-43. [DOI: 10.1016/j.jcjo.2012.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 04/11/2012] [Indexed: 10/26/2022]
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Abstract
OPINION STATEMENT The management of herpes zoster (HZ) usually involves a multidisciplinary approach aiming to reduce complications and morbidity. Patients with herpes zoster ophthalmicus (HZO) are referred to ophthalmologists for prevention or treatment of its potential complications. Without prompt detection and treatment, HZO can lead to substantial visual disability. In our practice, we usually evaluate patients with HZO for corneal complications such as epithelial, stromal, and disciform keratitis; anterior uveitis; necrotizing retinitis; and cranial nerve palsies in relation to the eye. These are acute and usually sight-threatening. We recommend oral acyclovir in conjunction with topical 3% acyclovir ointment, lubricants, and steroids for conjunctival, corneal, and uveal inflammation associated with HZO. Persistent vasculitis and neuritis may result in chronic ocular complications, the most important of which are neurotrophic keratitis, mucus plaque keratitis, and lipid degeneration of corneal scars. Postherpetic complications, especially postherpetic neuralgia (PHN), are observed in well over half of patients with HZO. The severe, debilitating, chronic pain of PHN is treated locally with cold compresses and lidocaine cream (5%). These patients also receive systemic treatment with NSAIDs, and our medical colleagues cooperate in managing their depression and excruciating pain. Pain is the predominant symptom in all phases of HZ disease, being reported by up to 90% of patients. Ocular surgery for HZO-related complications is performed only after adequately stabilizing pre-existing ocular inflammation, raised intraocular pressure, dry eye, neurotrophic keratitis, and lagophthalmos. Cranial nerve palsies are common and most often involve the facial nerve, although palsy of the oculomotor, trochlear, and abducens nerves may occur in isolation or (rarely) simultaneously. In our setting, complete ophthalmoplegia is seen more often than isolated palsies, but recovery is usually complete. Vasculitis within the orbital apex (orbital apex syndrome) or brainstem dysfunction is postulated to be the cause of cranial nerve palsies. A vaccine of a lyophilized preparation of the oka strain of live, attenuated varicella-zoster virus is suggested for patients who are at risk of developing HZ and has been shown to boost immunity against HZ virus in older patients.
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Affiliation(s)
- Srinivasan Sanjay
- Ophthalmology and Visual Sciences, Khoo Teck Puat Hospital, Alexandra Health, 90 Yishun Central, Singapore, 768828, Singapore,
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Nithyanandam S, Stephen J, Joseph M, Dabir S. Factors affecting visual outcome in herpes zoster ophthalmicus: a prospective study. Clin Exp Ophthalmol 2010; 38:845-50. [DOI: 10.1111/j.1442-9071.2010.02352.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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